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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by john anderton on August 17, 2006, at 18:31:20
Hi everyone: This will be a bit long winded so I am hopeful that some of you will take the time! I would sincerely appreciate your help!
I have been treated for GAD for nine years now. I have had four major bouts of GAD/depression breakout all in the late fall and in the years 97', 00', 03' 05'. I have been treated with the following drugs...Zoloft, Paxil, Celexa, Lexapro, and currently Effexor at 75mg's.
What I have noticed over the years is that the AD's seem to blast me out of the depression but I will continue to have episodes every few months that last a week or two. The feelings include feelings include suicidal thoughts, agitation, depressed but jumpy at the some time etc. Almost like a mixed state.
As a test last summer after enduring one of my nasty bouts while on 20 mg's of Lexapro, I decided to stop taking my medication. What followed was the obvious 6 weeks of horrible discontinuation. However, once I got through that I was stable with only minor blips that occured every two months or so up until the beginning of last December, where I tumbled back down into an anxious depressive state. I went back on the Lexapro and it did not do anything. We tried to add 600 mg's of Lithium and that only gave me horrible lower back pain. My doc said it was unfortunate because he believes in Lithium and that we had not gotten to a therapuetic dose. We quit both those and moved to Effexor this past April. I immediately felt better. For one month I felt out of this world good. No anxiety, no dpression, I was back!!! The just like that I tumbled back into waxing and waning since. We added Lamictal at my request as I have been researching Cyclothymia and I have been on ot for 5 weeks and I am currently at 37.5 mg's. We are moving slowly to avoid the rash.
My doctor (who is a renowned Psychopharmacologist in Southern Cal) still feels it is GAD with some depression thrown in. He said I definately do not have BP I or BP2, but I may have a low grade cyclothymia. He said he is unsure becasue the symptoms are not monster sized as in a terrible case of GAD or true manic depression. Well I can tell you....suicidal thoughts to me are not small and I hate them. I
I am an otherwise healthy 28 year old guy. I am a very successful broker, maintain a good partnership at work, own a nice home, am happily married, etc...from the outside nobody would ever know Im suffering...in fact they might say Im living the dream!
My questions are these:
Do you think I should just go back to Effexor and up the dose? Is it that I just need more AD?
Should I up the Lamictal and back off the Effexor? Since I did well for 6 months last year...is it not reasonable to think the AD's are speeding up my problem?
at 37.5 mg's should I be getting an antidepressant response from Lamictal or will that happen at a higher does?
I am so frustrated!
Im really stuck here...my gut tells me im cyclothymic...but very confused and really would like some advice!
Posted by Rani on August 18, 2006, at 4:02:52
In reply to Cyclothymic or GAD W/DEPRESSION?, posted by john anderton on August 17, 2006, at 18:31:20
Hi,
Sorry I wont be much help answering your questions however I am in the same situation.
Great job, happily family, happy marriage but wondering whether I am BPII or cycling.I also have the mixed state - depressed but with a strong element of agitation and anxiety. Feel reasonable some of the time and have some minor mania at others.
I am waiting to see a psychiatrist at the moment but my psychologist and family doctor tend to think I am cycling in some way.
I wonder if we need a diagnosis - for me I would like to know so I can do my part in helping myself. I torture myself wondering what is going on with me. My depression is almost intolerable and I dont know what is normal for me.
I too have had anxiety disorder in acute stages which has settled into GAD. The best thing I do is very strongly practice my Cognitive Behaviour Therapy which is considered with gold standard in treating anxiety disorder. It has had far better effect than any medication has to help treat my anxiety.
I too have had Paxil, Zoloft, Cipramil, Serzone and Luvox. I have started Lexapro in the past few days.
I do think that perhaps in some ways the SSRI's actually exacerbate my depression at some times. My anxiety was very simple prior to SSRIs but now I have this complex set of emotions since retaking the SSRI again. I do noticw that when I reduce my SSRI my mood lowers but does plateau again.My gut tells me that my SSRI is really making it worse.
> Hi everyone: This will be a bit long winded so I am hopeful that some of you will take the time! I would sincerely appreciate your help!
>
> I have been treated for GAD for nine years now. I have had four major bouts of GAD/depression breakout all in the late fall and in the years 97', 00', 03' 05'. I have been treated with the following drugs...Zoloft, Paxil, Celexa, Lexapro, and currently Effexor at 75mg's.
>
> What I have noticed over the years is that the AD's seem to blast me out of the depression but I will continue to have episodes every few months that last a week or two. The feelings include feelings include suicidal thoughts, agitation, depressed but jumpy at the some time etc. Almost like a mixed state.
>
> As a test last summer after enduring one of my nasty bouts while on 20 mg's of Lexapro, I decided to stop taking my medication. What followed was the obvious 6 weeks of horrible discontinuation. However, once I got through that I was stable with only minor blips that occured every two months or so up until the beginning of last December, where I tumbled back down into an anxious depressive state. I went back on the Lexapro and it did not do anything. We tried to add 600 mg's of Lithium and that only gave me horrible lower back pain. My doc said it was unfortunate because he believes in Lithium and that we had not gotten to a therapuetic dose. We quit both those and moved to Effexor this past April. I immediately felt better. For one month I felt out of this world good. No anxiety, no dpression, I was back!!! The just like that I tumbled back into waxing and waning since. We added Lamictal at my request as I have been researching Cyclothymia and I have been on ot for 5 weeks and I am currently at 37.5 mg's. We are moving slowly to avoid the rash.
>
> My doctor (who is a renowned Psychopharmacologist in Southern Cal) still feels it is GAD with some depression thrown in. He said I definately do not have BP I or BP2, but I may have a low grade cyclothymia. He said he is unsure becasue the symptoms are not monster sized as in a terrible case of GAD or true manic depression. Well I can tell you....suicidal thoughts to me are not small and I hate them. I
>
> I am an otherwise healthy 28 year old guy. I am a very successful broker, maintain a good partnership at work, own a nice home, am happily married, etc...from the outside nobody would ever know Im suffering...in fact they might say Im living the dream!
>
> My questions are these:
>
> Do you think I should just go back to Effexor and up the dose? Is it that I just need more AD?
>
> Should I up the Lamictal and back off the Effexor? Since I did well for 6 months last year...is it not reasonable to think the AD's are speeding up my problem?
>
> at 37.5 mg's should I be getting an antidepressant response from Lamictal or will that happen at a higher does?
>
> I am so frustrated!
>
> Im really stuck here...my gut tells me im cyclothymic...but very confused and really would like some advice!
>
Posted by silvercoin on August 18, 2006, at 8:02:46
In reply to Cyclothymic or GAD W/DEPRESSION?, posted by john anderton on August 17, 2006, at 18:31:20
Lamictal needs to be slowly titrated upward, but not to the extent of only 37.5 mg at 5 weeks. The manufacturer makes a starter kit that I've used; I believe the dosage obtained at 5 weeks is 100 mg/day. You need to get up to 200 mg/day to give the stuff a fair trial, and while some individuals certainly respond to lower levels, other people do not see any results until they get close to 200 (others such as myself do not find any benefit even at this dosage). The Effexor dosage of 75 mg/day is also on the low side. I have also experienced the phenomenon of an initial very positive response to a low dose of Effexor followed by a fading of therapeutic effects--I would advise considering a dosage increase.
Todd
Posted by john anderton on August 18, 2006, at 12:23:25
In reply to Re: Cyclothymic or GAD W/DEPRESSION?, posted by silvercoin on August 18, 2006, at 8:02:46
Todd:
Thanks for the feedback. You mentioned that this may be a "phenomenon" Have other people experienced this on Effexor? I felt so good on it that at the time I thought my troubles were behind me! Literally I felt like I had found a magic bullet and then wham.....loss of benefit. Now I am justs waxing and weaning from mood to mood....Do you know anyone who has experienced this and then upped the dose with a return of benefit?
Posted by Phillipa on August 18, 2006, at 15:08:49
In reply to Re: Cyclothymic or GAD W/DEPRESSION?, posted by john anderton on August 18, 2006, at 12:23:25
I've always heard that if an ad quits on you it won't work again this has happened to me. Maybe for your sake I'm wrong. Good luck Love phillipa
This is the end of the thread.
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